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. 2023 Jun 12;13(6):e065786.
doi: 10.1136/bmjopen-2022-065786.

Clinical characteristics of carbapenem-resistant Klebsiella pneumoniae infection/colonisation in the intensive care unit: a 9-year retrospective study

Fei Wang  1   2 , Xiaocui Zou  1 , Boting Zhou  1   3 , Tao Yin  1   3 , Ping Wang  4   3
Affiliations

Clinical characteristics of carbapenem-resistant Klebsiella pneumoniae infection/colonisation in the intensive care unit: a 9-year retrospective study

Fei Wang et al. BMJ Open. .

Abstract

Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection/colonisation has been reported in hospitals. The clinical characteristics of CRKP infection/colonisation in the intensive care unit (ICU) have received little attention. This study aims to investigate the epidemiology and extent of K. pneumoniae (KP) resistance to carbapenems, the sources of CRKP patients and CRKP isolates, and the risk factors for CRKP infection/colonisation.

Design: Retrospective single-centre study.

Data source: Clinical data were obtained from electronic medical records.

Participants: Patients isolated with KP in the ICU from January 2012 to December 2020.

Main outcome measures: The prevalence and changing trend of CRKP were determined. The extent of KP isolates resistance to carbapenems, the specimen types of KP isolates, and the sources of CRKP patients and CRKP isolates were all examined. The risk factors for CRKP infection/colonisation were also assessed.

Results: The rate of CRKP in KP isolates raised from 11.11% in 2012 to 48.92% in 2020. CRKP isolates were detected in one site in 266 patients (70.56%). The percentage of CRKP isolates not susceptible to imipenem increased from 42.86% in 2012 to 98.53% in 2020. The percentage of CRKP patients from general wards in our hospital and other hospitals gradually converged in 2020 (47.06% vs 52.94%). CRKP isolates were mainly acquired in our ICU (59.68%). Younger age (p=0.018), previous admission (p=0.018), previous ICU stay (p=0.008), prior use of surgical drainage (p=0.012) and gastric tube (p=0.001), and use of carbapenems (p=0.000), tigecycline (p=0.005), β-lactams/β-lactamase inhibitors (p=0.000), fluoroquinolones (p=0.033), and antifungal drugs (p=0.011) within the prior 3 months were independent risk factors for CRKP infection/colonisation.

Conclusions: Overall, the rate of KP isolates resistance to carbapenems increased, and the severity of this resistance significantly increased. Intensive and local infection/colonisation control measures are necessary for ICU patients, especially those with risk factors for CRKP infection/colonisation.

Keywords: adult intensive & critical care; epidemiology; infection control; microbiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The number (A) and distribution (B) of Klebsiella pneumoniae isolated sites. CRKP, carbapenem-resistant Klebsiella pneumoniae; CSKP, carbapenem-susceptible Klebsiella pneumoniae.
Figure 2
Figure 2
Trends in the prevalence of Klebsiella pneumoniae isolates non-susceptible to imipenem, meropenem and ertapenem.
Figure 3
Figure 3
Changing trends in the sources of patients with Klebsiella pneumoniae isolates. CRKP, carbapenem-resistant Klebsiella pneumoniae; CSKP, carbapenem-susceptible Klebsiella pneumoniae.
Figure 4
Figure 4
Distribution of the sources of Klebsiella pneumoniae isolates. CRKP, carbapenem-resistant Klebsiella pneumoniae; CSKP, carbapenem-susceptible Klebsiella pneumoniae; ICU, intensive care unit.
See this image and copyright information in PMC

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